On government and health care

Robert I. Field
Robert I. Field
Posted: December 02, 2013

What do Presidents Theodore Roosevelt, Franklin D. Roosevelt, Harry Truman, John F. Kennedy, Lyndon B. Johnson, Richard M. Nixon, and Bill Clinton all have in common?

They all supported the idea of national health coverage. In stepping back from the issues at hand with the Affordable Care Act, it's important to note how the idea of national health coverage has crossed party lines, from Republican to Democratic hands, and has been more than a hundred years in the making.

Though Barack Obama is the first American president to succeed in passing a universal health-care plan, in his new book Mother of Invention (Oxford University Press, 336 pp., $55), Drexel University law professor Robert I. Field, who leads " The Field Clinic" blog on Philly.com and Inquirer.com, reminds us that the idea of a national health plan isn't anything new. Nor is federal involvement in the U.S. health-care industry.

The book's central premise is that the government created the health-care system, often in hidden ways, and without it, we would not have the system we have.

So what would health care look like without the helping hands of the feds? No doubt, the intersecting parts of the system Field describes - the pharmaceutical and hospital industries, the medical profession and health insurers - would be much smaller and less effective.

So, how exactly did Obama succeed in doing what no other American president had been able to accomplish? Only by appeasing several sectors of the private market, Field notes.

In exchange for the backing of major insurers, the Obama administration refused to support the importation of overseas prescription drugs, which tend to be much cheaper. The Obama plan also mandated that millions of people would have to buy the companies' medications. And the American Medical Association, long an opponent of universal coverage, backed the health law because it would help doctors get paid for treating uninsured patients.

Federal programs have enabled the health-care industry to grow in astronomical ways. Medicare and Medicaid account for about half of the revenue of the health-care system, pushing more than $1 trillion into it every year. Without the government, there would be less access to care. Those without insurance could be turned away from emergency rooms.

Overall, Field thinks the private market owes the federal government a big thank-you for paving its path to financial prosperity.

The pharmaceutical industry provides a good example. The National Institutes of Health, along with its offshoot organizations, have led the way to research breakthroughs. Some have resulted in such profitable and widely used drugs as Lipitor, a cholesterol-lowering medicine. But private companies alone could not have funded the basic research behind the product, or put up the money needed for the Human Genome Project.

Though Field's investigation is compelling, his subject is vast and daunting. We come away knowing that the system is a delicate dance between the private and public sectors. It is the reason we have some of the best care in the world and why our system is the most expensive. Or, as Field puts it: "The public-private partnership has given us a system that is distinctive in its size rather than in its effectiveness."

Looking forward, Field points to problems that continue to plague the system. There are too many specialists and not enough primary-care doctors. The administrative complexities and bureaucracy of hospitals need to be reined in, and the proliferation of technology has made the system more costly and not always better. But in Field's view, the Affordable Care Act is a step in the right direction.

Field closes by noting that "debates over whether the government should intrude on American health care accomplish nothing." The government has and will continue to be involved in the American health-care industry, so "the question is not whether the government should be involved," but "how that involvement can be channeled most wisely."



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